title: Severely obese people with diabetes experience impaired emotional well-being associated with socioeconomic disadvantage: results from diabetes MILES - Australia.
abstract: OBJECTIVE
  To examine the emotional well-being of severely obese Australians with type 2 diabetes, along with markers of social and economic disadvantage, using the Diabetes MILES - Australia dataset.
  
  
  METHODS
  Diabetes MILES - Australia was a national survey of 3338 adults with diabetes that focused on psychosocial issues; 1795 had type 2 diabetes and reported BMI. We extracted data regarding depression (PHQ-9), anxiety (GAD-7), obesity- and diabetes-related comorbidities, and demographics. The severely obese group (SOG) (BMI ≥ 35; median BMI=41.6) constituted 530 (30%) of the type 2 diabetes respondents and was matched with 530 controls (CG) (BMI<35; median BMI=28.2). Within- and between-group trends were examined.
  
  
  RESULTS
  The SOG had higher depression scores (median (IQR) 6.0 (3-12)) than CG (5.0 (2-10)); p<0.001, and were more likely to report moderate-severe depressive symptoms (37% versus 27%; p<0.001). The groups did not differ on anxiety. The SOG, compared with the CG, were more likely to live alone (21% versus 17%), receive a disability pension (21% versus 15%), earn ≤$40.000/year (51% versus 41%; all p<0.05), and were less likely to be employed (46% versus 53%), university or higher educated (17% versus 26%), or have health insurance (50% versus 60%; all p ≤ 0.01). Moderate-severe depression was positively associated with cumulative stressors of severe obesity, socioeconomic disadvantage, and obesity- and diabetes-related comorbidity.
  
  
  CONCLUSIONS
  Severely obese people living with type 2 diabetes have cumulative stressors related to health, disability, demographic and socioeconomic factors, and impaired emotional well-being.
authors.affiliation: Clinical Obesity Research, Baker IDI Heart and Diabetes Institute, Melbourne, Australia. john.dixon@bakeridi.edu.au
authors.forename: John B
authors.initials: JB
authors.lastname: Dixon
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Browne
authors.forename: Gavin W
authors.initials: GW
authors.lastname: Lambert
authors.forename: Kay M
authors.initials: KM
authors.lastname: Jones
authors.forename: Prasuna
authors.initials: P
authors.lastname: Reddy
authors.forename: Frans
authors.initials: F
authors.lastname: Pouwer
authors.forename: Jane
authors.initials: J
authors.lastname: Speight
mesh_terms: D000368:Aged; D003863:Depression / Q000453:epidemiology / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology* / Q000523:psychology*; D012923:Social Class
keywords: Depression; Psychosocial comorbidity; Severe obesity; Socioeconomic disadvantage; Type 2 diabetes